title: Comparison of left atrial electrophysiologic abnormalities during sinus rhythm in patients with different type of atrial fibrillation.
abstract: OBJECTIVE
  The purpose of this study is to explore the left atrium (LA) electrophysiologic abnormalities in atrial fibrillation (AF) patients detected during sinus rhythm and to determine the relationship between the type of AF and the electrophysiologic substrate in the LA.
  
  
  METHODS
  Eighty patients with AF (30 paroxysmal AF, 22 persistent AF, and 28 long-standing AF) and 20 age- and sex-matched patients with left-sided accessory pathway were prospectively studied. High-density three-dimensional electroanatomic mapping was performed during sinus rhythm in LA, which was divided into six segments for regional analysis. Mean bipolar voltage, low voltage zone (LVZ) distribution, LA activation time, and electrogram complexity were assessed.
  
  
  RESULTS
  The LA mean voltage was 3.67 ± 0.68 mV in no AF group, 2.16 ± 0.63 mV in the paroxysmal, 1.81 ± 0.36 mV in the persistent, and 1.48 ± 0.34 mV in the long-standing AF patients (P < 0.001). The total LA activation time was 75.3 ± 5.4 ms in no AF, 89.7 ± 12.3 ms in paroxysmal AF, 104.9 ± 6.1 ms in persistent AF, and 115.6 ± 12.1 ms in the long-standing AF patients, respectively (P < 0.001). With the progression of AF, there was a higher incidence of LVZ detection and increased prevalence of complex electrograms with 95 % of complex electrograms in areas with the bipolar voltage ≤ 1.3 mV in persistent and long-standing AF patients.
  
  
  CONCLUSIONS
  Patients with AF have abnormal electrophysiologic substrate in sinus rhythm characterized by lower mean bipolar voltage, more prevalent complex electrograms, and longer LA activation time. This substrate progresses parallel to progression of AF type.
authors.affiliation: Cardiology Division, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China.
authors.forename: Yazhou
authors.initials: Y
authors.lastname: Lin
authors.forename: Bing
authors.initials: B
authors.lastname: Yang
authors.forename: Fermin C
authors.initials: FC
authors.lastname: Garcia
authors.forename: Weizhu
authors.initials: W
authors.lastname: Ju
authors.forename: Fengxiang
authors.initials: F
authors.lastname: Zhang
authors.forename: Hongwu
authors.initials: H
authors.lastname: Chen
authors.forename: Jinbo
authors.initials: J
authors.lastname: Yu
authors.forename: Mingfang
authors.initials: M
authors.lastname: Li
authors.forename: Kai
authors.initials: K
authors.lastname: Gu
authors.forename: Kejiang
authors.initials: K
authors.lastname: Cao
authors.forename: David J
authors.initials: DJ
authors.lastname: Callans
authors.forename: Francis E
authors.initials: FE
authors.lastname: Marchlinski
authors.forename: Minglong
authors.initials: M
authors.lastname: Chen
mesh_terms: D001281:Atrial Fibrillation / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology*; D018780:Body Surface Potential Mapping / Q000379:methods*; D056966:Excitation Contraction Coupling; D005260:Female; D006325:Heart Atria / Q000503:physiopathology*; D006329:Heart Conduction System / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D066298:In Vitro Techniques; D008297:Male; D008875:Middle Aged